Army Uses Virtual Tool in its Battle with PTSD

Sgt. Chad Parrott and Capt. Greg Reger demonstrate a simulator used to help in the treatment of PTSD at Madigan Army Medical Center.

Sgt. Chad Parrott and Capt. Greg Reger demonstrate a simulator used to help in the treatment of PTSD at Madigan Army Medical Center.

FORT LEWIS, Wash. (Army News Service, March 23, 2007) - The Humvee rumbles down the narrow desert road. To the left and right there is nothing but an expanse of beige sand, with an occasional palm tree sprinkled here and there.

Looking up through the gunner's hatch, the sky is blue and cloudless. It seems like a normal day - until the attack begins.

The ground trembles underfoot while the sound of gunfire and explosions pierce the air. The Humvee in front blows up, leaving a blackened shell in the road. A Black Hawk roars overhead. The only thing to do is keep driving and not panic. Finally, the sounds of battle cease, and all returns to normal again.

The scenario may sound terrifying, but there is no need to fear. It's not reality - it's virtual reality. And it is part of a new therapy for combat related Post Traumatic Stress Disorder - PTSD - being fine-tuned at Madigan Army Medical Center.

"PTSD occurs after an individual is subjected to, or witnesses, what they perceive as a life threatening event," explained Capt. Greg Reger, Ph.D., a clinical psychologist for 62nd Medical Brigade.

There are basically three clusters of symptoms that coincide with PTSD: re-experiencing, which could include nightmares or flashbacks; avoidance, when the patient avoids cues or reminders of the event; and hyperarousal or numbing, which could include hypervigilance or suspiciousness.

"These symptoms happen at least one month after the traumatic event and significantly interfere with (the Soldiers') work or their relationships," Reger noted.

PTSD causes humans to associate cues in the environment - that were previously normal - with life-threatening events. If a Soldier was in a convoy that was attacked in Iraq, the Soldier might associate that event with driving on I-5, causing that person's body to respond as if that were a life-threatening situation, even though it is nothing more than the daily commute.

Currently, the standard treatments for PTSD are exposure therapies. Reger uses the analogy of a child who fears dogs after being bitten to explain how the therapy works. The best way to diminish the child's fear is to slowly and progressively habituate the child to being around dogs again. The child might start by thinking about being around a dog and eventually work up to petting one, until the child is comfortable around dogs again.

However, exposure therapies can be difficult for combat-related PTSD, because Soldiers cannot be re-exposed to combat as part of therapy, Reger said. Previously, Soldiers had to rely on recalling memories of combat as part of their PTSD treatment, which can be very difficult and painful, he went on. That is where the new technology comes in.

"Virtual reality allows us a means of delivering these potentially traumatic-event experiences to Soldiers that was previously not possible," Reger said. "It's a technological tool to improve our already gold standard of care with exposure therapy."

Inside the virtual-reality helmet, the patient is afforded a 360-degree view of two scenarios, a convoy through the desert or a foot patrol through a city. A video-game-style handset controls movement through the scene. Beneath the platform on which the patient sits or stands, speakers provide the rumbling sensation of the convoy and the attack. The scenario can be altered to fit the Soldier's experience. It can be a sunny day, dusk or night. It can even be turned to the green tones of night vision, if that is what the Soldier recalls.

Eventually, the technology may include a system that delivers scents like burning rubber or Iraqi spices that could trigger memories for the Soldier. It is also designed to be able to monitor physical reactions like heart rates, which will help the clinician track the Soldier's reaction to the therapy, Reger explained.

MAMC is the only Army medical center testing this particular virtual reality technology.

"Here at Fort Lewis, we have the only Army Behavioral Health Technology Office, which is designed to explore and develop a range of new technologies for Army Behavioral Health," said Col. Gregory Gahm, Ph.D., chief of the department of psychology. "Virtual reality is one of those."

Currently at MAMC, the research team, which consists of Gahm, Reger and Robert Swanson, Ph.D., research and post-doctoral psychologist, is gathering feedback from Soldiers who have deployed in the last year and are not exhibiting symptoms of PTSD. The goal is to get feedback from 300 Soldiers to make the technology as realistic and functional as possible. The team hopes to have virtual reality available as a treatment option by this summer.

The virtual-reality research project has been a collaboration of many organizations.

The original research for the technology was done by Dr. Albert Rizzo at the Institutes for Creative Technologies, University of Southern California, and funded by the Office of Naval Research. The research to fine-tune the technology is being funded by Telemedicine and Advanced Technology Research Center.